Title: Paramedic Non-Technical Skills (ParaNOTS)

Recent research in healthcare has indicated that adverse events are often caused by failures in communication, judgement, teamwork and other non-technical aspects rather than technical failings.  There has been little research, to date, which has concentrated on the non-technical skills of paramedics. Non-technical skills are the cognitive and social skills that complement technical skills to achieve safe and effective performance.  Cognitive or thinking skills include attention, anticipation and awareness i.e. recognising and understanding cues in the environment to enable anticipation of events and to adjust performance accordingly.  Social skills include teamwork and communication.

It is hoped that this project will identify the non-technical skills for the role of paramedic with a view to developing a behavioural rating system which will be designed to train and assess those non-technical skills in paramedics in the pre-hospital setting.


Improving self-referral to primary care Following Hypoglycaemic emergencies: The development and initial assessment of a research-based intervention. (externally funded)

Although diabetic care has improved, there are still key gaps in services. In particular, many people who have a hypoglycaemic emergency and are left at home by ambulance clinicians receive inadequate follow-up. Relatively few attend their diabetic care provider for review. This study will develop and assess an intervention to promote follow-up of hypoglycaemic emergencies. 
Status: On-going
Partners: Dr Edward Duncan (NMAHP RU), professor Vikki Entwistle (University of Dundee), Fitzpatrick D (Scottish Ambulance Service), Dr Helen Cheyne (NMAHP RU), Mr John Paley (University of Stirling), Professor Catherine Niven (NMAHP RU), Professor Brian Frier (University of Edinburgh) and Professor Frank Sullivan (university of Dundee). 
Diabetes UK (£99,850). 2009-2011


Developing a prioritised vehicle equipment check-sheet (VECS): a modified Delphi study

This “Delphi” study seeks to develop a consensus on the order in which equipment is checked on front-line accident and emergency ambulances ensuring vital equipment is checked first. It is anticipated this will reduce risk to patients and improve check procedures.  
Status: Completed
Partners: Dr Edward Duncan (NMAHP RU) and David Fitzpatrick (Scottish Ambulance Service)


Treat and Refer guidelines: Do we like them? Do we use them?

There have been increasing demands on emergency healthcare in Scotland with pressure on all services to reduce patient admissions. To help address these demands, the SAS introduced four Treat and Refer guidelines for all emergency ambulance crews which transferred responsibility from hospital staff to the ambulance crew. Traditionally, ambulance crews transported all emergency/999 patients by ‘‘default’’ and did not receive any formal training/education, protocols or guidelines to support decisions for referral or discharge.  This study aimed to seek views on the concept and implementation of Treat and Refer and to identify factors which influence the usage.
Status: Completed
Partners: Professor Len Dalgleish (University of Stirling), Keith Colver (Scottish Ambulance Service), D Fitzpatrick (Scottish Ambulance Service).


Ambulance clinician decision making 

Furthering earlier work on study 1 “Treat and Refer”, Keith Colver, as part of a Masters in Philosophy is undertaking in-depth analyses of the original interviews undertaken with ambulance clinicians. Study two aims to achieve a greater understanding of the themes from study 1 “Treat and Refer”, establishing if there was an underlying cause[s] to the findings.  Following a review of the literature one of the aims of the study is to explore and identify theories in the decision-making literature which may enhance the decision making abilities of ambulance crews when dealing with ‘treat and refer’ cases.
Status: Ongoing
Partners: Keith Colver (Scottish Ambulance Service), Professor Len Dalgleish (University of Stirling), Professor Kate Niven (University of Stirling)  , Dr Purva Abhyankar, (University of Stirling),  David Fitzpatrick (Scottish Ambulance Service).


Reperfusion of the old or new: left bundle branch block

SAS audit data over a 12 month period suggested only one patient with Acute Coronary Syndrome who had ECG changes depicting Left Bundle Branch Block received pre-hospital thrombolytic therapy.  Anecdotal evidence suggests that paramedics are failing to thrombolysis these patients as they cannot determine whether such ECG changes are new or old.  A suggestion has been made to improve the pre-hospital thrombolysis rate of patients with Acute Coronary Syndrome (ACS) and Left Bundle Branch Block (LBBB) via the introduction of LBBB alert cards for patients with CHD who have known LBBB.  This would prevent known CHD patients presenting with chest pain and LBBB ECG changes from being exposed unnecessarily to the risks of thrombolysis; and transportation to PPCI centres. 

Status: Completed

Partners: L David Fitzpatrick (Scottish Ambulance Service) and Scott McLean (Edinburgh Royal Infirmary).  


Multi-Professional Responses to Mental Health Calls: Knowledge, practice, and decision-making: (Externally funded)

This project focuses upon the knowledge, practices, and decision-making that circulates through the interactions of multiple professionals responding to mental health emergencies. It particularly concentrates on mental health knowledge, professional knowledge differences, knowledge which is required for inter-professional linkages and communication and the extent to which decision making authority affects the care pathway.

Status: On-going

Partners: Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling: Dr. Edward Duncan,, David Fitzpatrick,,  Scottish Ambulance Service Stirling Institute of Education: Professor Tara Fenwick,, Dr. Tim Essington,


Acute exacerbation of Chronic Obstructive Pulmonary Disease: preventing hyper-oxygenation in the pre-hospital environment

Evidence suggests patients with Chronic Obstructive Pulmonary Disease (COPD) are still receiving higher than required levels of oxygen in the pre-hospital phase of their treatment and that this is having a detrimental effect on ongoing care.

Retrospective case-note analysis is being undertaken on patients with Chronic Obstructive Pulmonary Disease.  The study aims to determine pre-hospital and emergency department treatment patterns of oxygen therapy and hopes to determine short-term patient outcome. This is a preliminary investigation which aims to support the introduction of pre-hospital alert system for chronic CO2 retainers.
Status: On-going

Partners: David Fitzpatrick (Scottish Ambulance Service), Dr Donogh Maguire (Monklands District General Hospital), Dr Edward Duncan (NMAHP RU)